Reproductive Outsourcing

The outsourcing of U.S. jobs has become an important topic in the current election cycle. That this "job" outsourcing now has also seriously entered fertility practice is, however, less well known.
It all started with gamete donations. Scandinavian sperm banks flouted world wide their blond, blue eyed sperm donors with college education. As the popularity of egg donations increased, the former Communist countries of Eastern Europe became sources of inexpensive egg donation. Special egg donation clinics were, amongst other places, set up in the Czech Republic, Ukraine and Russia.
Now, The New York Times reports on the latest form of reproductive outsourcing,- surrogate motherhood (Gentleman A. March 10, 2008, A9).
Overlooking the misappropriation of terminology (we are really not talking here about surrogates, but gestational carriers), this report is rather remarkable because it, once again, demonstrates how far people are willing to go in the pursuit of having children and building a family.
Gestational carriers have to be differentiated from true surrogates because the former have no genetic contribution to the pregnancy they carry. A true surrogate contributes her egg(s) to the process. Gestational carriers are, nevertheless, even in medical lingo often referred to as "surrogates" and we, therefore, will follow this terminology here, as well.
Commercial surrogacy is, of course, quite common nowadays in the U.S.. It, indeed, in some states has become subject to special legislation, which denotes children of gestational carriers rather automatically as children of their genetic parents. In states where such law does not exist, the birth mother is still considered the legitimate parent and donors of egg and sperm have no automatic parental rights.
Many European countries ban commercial surrogacy outright. In the U.S., when available, the process is extremely expensive.
Who can then be surprised that the third world has picked up on this opportunity. As Gentleman now reports in The New York Times, India is in the process of developing commercial gestational surrogacy into yet another successful outsourcing industry for their country. Legalized in India in 2002, they offer easy access to surrogates and, most importantly low cost. At approximately $25,000, IVF cycle included, costs are approximately one third of the average surrogacy attempt in the U.S. Who then can be surprised that patients from Europe, Israel and the U.S. allegedly have started flocking to Mumbai and Dehli (On a side note, The Center for Human Reproduction in Mumbai has no connections with The Center for Human Reproduction in New York City, which advertises occasionally on this website).
An Israeli couple, quoted in the New York Times article, used long-distance donated eggs (most likely from an East European donor), after reviewing egg donor profiles by e-mail, the husband's semen and an Indian gestational carrier to achieve their goal. Photos of egg donor and surrogate are plastered on the walls of their apartment in Israel.
There is, of course, in principle, nothing wrong with reproductive outsourcing but in practice things may look differently: The New York Times addressed some of the social issues that apply to the specific Indian circumstances of surrogacy. It, for example, can be easily seen how economic interests may take advantage of poor women in third world countries, whether in Asia or Europe.
Our primary concerns with reproductive outsourcing are, however, more medically motivated: How well are egg donors evaluated? How detailed are their medical, family and genetic histories taken? How accurate are their medical evaluations?
Whether it is an egg donor or the gestational carrier of my pregnancy, I would like to be certain that every i was dotted in the process of selecting my donor/surrogate. Considering recent experiences with outsourcing in much less sensitive areas, there is at least reason to be concerned. If it was me, I would be willing to shoulder higher costs to avoid those concerns.